The truth about; the natural alternative to HRT

A balanced diet rather than dosing up on supplements may be the safest route to a healthy menopause

Hormone replacement therapy has been getting a bad press of late. Despite recent research showing that it can increase life expectancy by up to three-and-a-half years, other studies indicating an increased risk of blood clots and breast cancer do little to inspire confidence. With 15 women trying to sue the drug companies for alleged side-effects, is the answer just to grow old gracefully?

A small but growing band of doctors and nutritionists argue that, rather than just putting up with hot flushes, mood swings and osteoporosis, women can alleviate the worst symptoms of the menopause naturally. It's all a matter of what you eat.

Ellen Grant, a British doctor and an ardent campaigner against HRT and the Pill, first suggested a link between dietary deficiencies and menopausal symptoms in the Sixties. The latest contribution to the debate comes from Marilyn Glenville, a psychologist turned nutrition expert. In her book, Natural Alternatives to HRT (Kyle Cathie, pounds 9.99), she recommends boosting vitamins E and C and magnesium and calcium for hot flushes, taking vitamin D for osteoporosis, and eating plenty of soya foods, which contain phyto-oestrogens and, she says, balance out hormonal changes.

We all know that vitamins and minerals play an important role in our general health. Too little vitamin C, and you get scurvy. Pregnant women should take folic acid to reduce the risk of producing a baby with spina bifida. Low levels of the protein tryptophan can trigger depression. A study from Cambridge University last year showed that a daily dose of vitamin E reduced the risk of heart attack by 75 per cent. But can nutrients really alleviate hot flushes, or offset osteoporosis?

Although nutrition scientists have no doubt about the importance of nutrients, there is still only limited research to support these claims. Take soya, for example, which is found in tofu, soya milk and miso. Japanese women, apparently, don't have a word for "hot flushes", as they don't have them; scientists have speculated that this (as well as lower rates of breast cancer) may be due to soya in the diet. But no one is certain whether other, as yet unidentified, factors in the Japanese diet or lifestyle play a role. Two American studies showed slight alleviation of menopausal symptoms after taking soya, but neither was conclusive.

Certainly, there is enough interest in soya's potential health benefits to warrant a major EC-funded trial, currently taking place. But rather than rushing out to stock up on soya milk, it may be better to wait for the results; there have been suggestions that the chemical interactions between soya and other foods may be harmful, blocking protein digestion. Earlier experiences with beta-carotene should serve as a warning: American trials of its use to prevent cancer were halted last year after a Finnish study showed smokers taking the supplement had, unexpectedly, higher rates of lung cancer and a higher mortality rate.

The book also recommends a daily supplement of vitamin E - found in olive oil, avocado and tuna - for hot flushes. Studies from the Forties showed that hot flushes ceased when women took this supplement, but little research into vitamin E and the menopause has taken place since.

Magnesium, argues Glenville, is essential to help prevent osteoporosis. There is some evidence to support this: a 1991 study showed that bone mineral density increased by 11 per cent in women taking 250mg of magnesium a day.

But until there is a conclusive, full-scale trial, the safest approach for women approaching the menopause may be to eat a healthy, balanced diet rather than dose up on supplements. Unfortunately, it could be a long wait before sufficient research into "natural" remedies has been carried out.